Diagnóstico prenatal de masa suprarrenal: secuestro pulmonar intraabdominal, una entidad a tener en cuenta / Prenatal diagnosis of an adrenal mass: Intra-abdominal pulmonary sequestration, an entity to consider in diagnosis

Los secuestros pulmonares son anomalías congénitas infrecuentes pero bien reconocidas. En los últimos años han mostrado un aumento de su incidencia en relación a los controles ecográficos rutinarios a los que son sometidas las gestantes. Por ello y a pesar de que representan tan solo entre el 0,15-6,45% de todas las malformaciones congénitas pulmonares constituyen entre el 8 y el 23% de los diagnósticos prenatales de anomalías pulmonares. El secuestro pulmonar extralobar infradiafragmático es una anomalía congénita extremadamente rara. La mayoría de estas lesiones se localizan en el hemiabdomen izquierdo siendo importante el diagnóstico diferencial con masas suprarrenales. El secuestro pulmonar debería ser considerado en todo neonato con masa abdominal superior o suprarrenal, sobre todo en casos de diagnóstico prenatal (AU)

Congenital lung sequestrations are uncommon but are well recognized. Recently, the incidence of these anomalies has increased due to routine ultrasound scans in pregnant women. Although these anomalies represent only 0,15% to 6,45% of all pulmonary malformations, they constitute between 8% and 23% of the prenatal diagnosis of lung abnormalities. Extralobar pulmonary sequestration is an extremely rare congenital infradiaphragmatic anomaly. Most of these lesions are located in the left abdomen and differential diagnosis with adrenal masses is essential. Pulmonary sequestration should be considered in any infant with an upper abdominal or adrenal mass, especially when diagnosis is prenatal (AU)

¿Es necesaria o imprescindible la cirugía experimental en el programa formativo de un cirujano pediátrico? / Is experimental surgery necessary or essential in the training program of a pediatric surgeon?

Muchas técnicas quirúrgicas realizadas en la cirugía pediátrica presentan una curva de aprendizaje lenta(1), el volumen de pacientes objeto de nuestra especialidad y la existencia de patologías complejas, que requieren gran entrenamiento y habilidad quirúrgica, han llevado a nuestro servicio a poner en marcha un programa formativo integral de cirugía experimental. Este programa, basado en la simulación y en la realización de procedimientos invasivos y mínimamente invasivos en modelos anatómicos reales, tiene como objetivo principal instruir de manera eficaz y global a los residentes, para así conseguir una mejoría de la formación técnica, y un aumento de la seguridad de los pacientes fruto de la experiencia y competencia adquirida en el campo de experimentación. Este trabajo presenta las características principales, objetivos y resultados obtenidos con este programa formativo e intenta promoverla incorporación de programas de simulación y experimentación en animales vivos como una parte esencial de la formación del residente de cirugía pediátrica (AU)

Many surgical procedures performed in pediatric surgery have a slow learning curve(1), the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident (AU)

[Is experimental surgery necessary or essential in the training program of a pediatric surgeon?]. / ¿Es necesaria o imprescindible la cirugía experimental en el programa formativo de un cirujano pediátrico?

Many surgical procedures performed in pediatric surgery have a slow learning curve, the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident.

[Role of alpha antagonists in uncoordinated micturition syndrome in childhood]. / Papel de los alfa-antagonistas en el síndrome de micción no coordinada en la infancia.

INTRODUCTION: Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. OBJECTIVE: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. MATERIAL AND METHODS: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. RESULTS: There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness. CONCLUSIONS: Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.